Summary: With the medical advances and rising expectations among cardiac surgeons and patients, older and sicker patients now undergo ever more complex operations. However, fortunately, postoperative care of cardiac surgical patients also have shown important changes parallel to the surgical improvements. Although, the events within the operating room are accepted as the main determinants for the faith of the patient, some patients, who are very ill upon arrival in the intensive care unit, may have a good long-term prognosis when postoperative care is meticulously provided. Conversely, patients who are doing well as they leave the operating room may be put at significant risk for complications by poor postoperative management. In this paper, we draw an outline of systematical approach of intensive care of cardiac surgical patients and summarize a practical manual for physicians. By applying this approach effectively, it should be expected that, the clinician is able to recognize an impending disaster earlier, initiate the proper treatment timely, and increase patient’s chances of survival.